Recipient may have normal immunity if homozygous for a HLA haplotype and donor is heterozygous with one shared haplotype, which causes donor cells to see recipient cells as foreign but recipient cells don't see donor cells as foreign (high risk if directed donations from first or second degree relatives); also risk factor in rural areas where gamma radiation is not possible (Transfusion 2007;47:1405, Indian Pediatr 2004;41:1260)

Diagnosis

Diagnosis based on clinical findings and laboratory and biopsy results

Easily confused with severe viral illness or adverse reaction in severely ill patients if Ta-GVHD is not suspected - considered to be underdiagnosed and underreported

Confirm diagnosis by finding donor lymphocytes or DNA in patient's peripheral blood or tissue biopsy, with the appropriate clinical symptoms

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